NÜZHET SEDEN KOCABAŞ, Oğuz ERİŞ, Haşim AKSU, Füsun AKDENİZ

Rejyonel anestezide propofol sedasyonunun hemodinamik, solunumsal ve kognitif işlevlere etkisi

Çalışmamızda, rejyonel anestezi olgularında propofol ile sedasyonun hemodinamik ve solunumsal parametreler ile kognitif işlevler üzerine olan etkilerinin araştırılması amaçlandı. Ortopedik cerrahi planlanan 25 hastaya preoperatif dönemde kognitif işlevlerinin değerlendirilmesi amacıyla Kısa Kognitif Muayene (KKM) Testi uygulandı. Rejyonel anestezi (spinal anestezi, epidural anestezi, brakiyal pleksus bloğu) uygulanmasını takiben propofol infüzyonuna 6 mg/kg/saat dozunda başlandı, lO.dk'da 4 mg/kg/saat dozuna inildi ve operasyon sonlanana dek Ramsay Skalası' na göre sedasyon düzeyi = 3 olacak şekilde doz ayarlandı. Operasyon süresince hemodinamik (sistolik, diyastolik ve ortalama arter basınçları, kalp atım hızı) ve solunumsal (solunum sayısı,periferik oksijen satürasyonu, end-tidal karbondiyoksit basıncı) parametreler ile sedasyon skorlamaları her 5 dk. 'da bir kaydedildi. Operasyonun sonlanması ile birlikte propofol infüzyonu sonlandırılarak, hastanın göz açmasına ve doğum tarihini söylemesine dek geçen süreler kaydedildi, postoperatif 5.dk'da hastalara KKM Testi tekrarlandı. Çalışmamız sonucunda, propofol infüzyonu süresince tüm hemodinamik parametrelerde istatistiksel olarak anlamlı bir azalma (p0,05). Propofol sedasyonu sonlandırıldığında kognitif fonksiyonlarda hızlı bir derlenme olduğu saptandı. Çalışmamız sonucunda, rejyonel anestezi olgularında sedasyon skorunun yakın takibi ile uygulanan propofol sedasyonunun kognitif işlevlerde hızlı bir derlenme sağlayan, hemodinamik ve solunumsal stabiliteyi koruyan, minimal yan etkiye sahip ve güvenilir bir yöntem olduğunu düşünmekteyiz.

Anahtar Kelimeler:

Solunum, Kavrama yeteneği, Anestezi, blok, Bilinçli sedasyon, Propofol, İleriye dönük çalışma

Hemodynamic, respiration and cognitive effects of propofol sedation during regional anesthesia

Sedation during regional anaesthesia can decrease patient anxiety and enhance patient comfort. The hemodynamic, respiratory and cognitive effects of subanesthetic doses of propofol, given by continuous infusion during regional anaesthesia were studied. This study included 25 adult patients, scheduled to undergo orthopaedic surgical procedures with regional anaesthesia. Preoperatively, patients completed the Short Cognitive Examination Test. Regional block spinal, epidural or brachial plexus) was performed by the anaesthetists. After regional anaesthesia had been performed, continuous infusion of propofol was started. Propofol infusion was commenced at 6 mg/kg/h and reduced to 4 mg/kg/h after 10 min. Infusion rates were adjusted to maintain an appropriate level of sedation (level 3) on Ramsay Scale. Hemodynamic and respiratory parameters and sedation scores were noted every 5 min. during the operation. The presence of any side effects was noted. Propofol infusion was discontinued 10 min. before the anticipated end of the operation. The times taken from the end of the infusion for the patients to open their eyes and to give their correct date of birth were noted. Postoperatively, recovery of cognitive function was assessed by repeating the Short Cognitive Examination Test. There were statistically significant decreases in systolic, diastolic and mean arterial blood pressures and heart rate, but no significant changes of respiratory parameters were observed. Hemodynamic stability was maintained in all patients and incidence of side effects was low. There was rapid recovery and restoration of cognitive function during the early postoperative period. There were no significant changes in pre and postoperative cognitive test results. As a result of our study, we conclude that propofol infusion provides safe and satisfactory sedation with rapid recovery of cognitive function during surgery under regional anaesthesia.

Keywords:

Respiration, Cognition, Anesthesia, Conduction, Conscious Sedation, Propofol, Prospective Studies,

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